It is well known that nutrition plays a major role in the prevention and management of several chronic diseases, including type 2 diabetes and chronic kidney disease, as well as cardiovascular disease, metabolic syndrome, and overweight and obesity. Chronic disease is very common in the United States and nearly 70% of American adults are overweight or obese. Health conditions triggered by overweight or obesity such as hypertension or hyperlipidemia, among others, are commonly treated with prescription drugs. Indeed, in a study of prescription drug trends published in 2015 in the Journal of the American Medical Association, it was found that 59% of American adults used prescription drugs between 2011 and 2012, up from 51% in 1999-2000. Furthermore, 15% of Americans used at least five prescription drugs in 2011-2012, compared to just 8% in 1999-2000. In particular, the prevalence of drug use increased in several categories of medication that may be made less necessary by improved nutrition, including antihyperlipidemic agents, antihypertensives, beta-blockers, and diuretics.
While healthcare providers and patients alike are aware of the role of nutrition, implementing behavior change to improve patients’ diets can be extremely difficult. The American College of Preventive Medicine (ACPM) indicates in their Lifestyle Medicine Curriculum that implementing nutrition and exercise prescriptions into primary care practices can be an effective way to change specific lifestyle behaviors that influence health. Capitalizing on the specific dosage, content, and frequency information included in a medication prescription, healthcare providers can give patients specific direction on how to eat more healthfully or to include physical activity in their routines.
Community-based programs like the South Side Diabetes Project in Chicago have implemented nutrition prescriptions into their patient management program with positive results, working with Walgreens to improve access and affordability of nutrient-dense foods. Beyond indicating to patients that they should eat more high fiber foods, for example, ACPM recommends that providers write very specific directions for patients, such as “eat one cup of a high-fiber vegetable five times per week for twelve weeks,” and provide specific examples of what vegetables would meet the high-fiber criteria. The Academy of Nutrition and Dietetics has published specific practice guidelines for many years to improve diet-related conditions like diabetes through the use of nutrition prescriptions and medical nutrition therapy.
For some conditions like chronic kidney disease or diabetes, nutrition prescriptions can be used alongside specialized medical foods for complete medical nutrition therapy. The Food and Drug Administration defines a medical food as, “A food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.”
The Joslin Diabetes Center has done extensive research on the role of medical foods in managing diabetes and has found that they play an important role in diabetes management, treatment, and even reversal. In combination with a low-glycemic-load diet, researchers found that medical foods can result in a “less atherogenic lipoprotein profile and lower plasma homocysteine” in women with metabolic syndrome.
By writing nutrition prescriptions that emphasize to patients the importance of consuming complete and high-quality nutrients from whole foods and medical foods, healthcare providers may reduce their patients’ dependence on prescription drugs. While changing eating behaviors can be very difficult, specific and targeted nutrition prescriptions may help get patients to change behavior and adopt a more healthful dietary pattern.
References
Ash, S; KL Campbell; J Bogard; A Millichamp. Nutrition Prescription to Achieve Positive Outcomes in Chronic Kidney Disease: A Systematic Review. Nutrients. 2014;6(1):416-451.
Jones, JL; ML Fernandez; MS McIntosh; W Najm; MC Calle; C Kalynych; C Vukich; J Barona; D Ackermann; JE Kim; V Kumar; M Lott; JS Volek; RH Lerman. A Mediterranean-style low-glycemic-load diet improves variables of metabolic syndrome in women, and addition of a phytochemical-rich medical food enhances benefits on lipoprotein metabolism. Journal of Clinincal Lipidology.2011;5(3):188-196.
Kantor, ED; C Rehm; JS Haas; AT Chan; EL Giovannucci. Trends in Prescription Drug Use Among Adults in the United States from 1999-2012. JAMA. 2015;314(17):1818-1830.
Monk, A; B Barry; K McClain; T Weaver; N Cooper; MJ Franz. Practice Guidelines for Medical Nutrition Therapy Provided by Dieticians for Persons with Non-Insulin Dependent Diabetes Mellitus. Journal of the American Dietetic Association. 1995;95(9):999-1006.
